<html xmlns:xf="http://www.w3.org/2002/xforms" xmlns:xsd="http://www.w3.org/2001/XMLSchema">
  <head>
    <title>PACT Demo Form</title>
    <xf:model>
      <xf:instance id="pact_demo_form">
        <pact_demo_form name="PACT Demo Form" id="1">
          <pact_office_visit/>
          <home_visit/>
          <outpatient/>
          <recent_medical_appointment/>
          <recent_medical_appoint_type/>
          <date_of_recent_medical_appointment_type/>
          <accompanied/>
          <talked_about_recent_slash_upcoming_appointments/>
          <reviewed_patient_apos_s_cd4/>
          <completed_new_qsp/>
          <topic_1_-_introduction/>
          <topic_2_-_using_a_pillbox/>
        </pact_demo_form>
      </xf:instance>
      <xf:bind id="pact_office_visit" nodeset="/pact_demo_form/pact_office_visit" type="xsd:int"/>
      <xf:bind id="home_visit" nodeset="/pact_demo_form/home_visit" type="xsd:int"/>
      <xf:bind id="outpatient" nodeset="/pact_demo_form/outpatient" type="xsd:int"/>
      <xf:bind id="recent_medical_appointment" nodeset="/pact_demo_form/recent_medical_appointment" type="xsd:string"/>
      <xf:bind id="recent_medical_appoint_type" nodeset="/pact_demo_form/recent_medical_appoint_type" type="xsd:string" relevant="/pact_demo_form/recent_medical_appointment != 'no'" action="hide" required="false()"/>
      <xf:bind id="date_of_recent_medical_appointment_type" nodeset="/pact_demo_form/date_of_recent_medical_appointment_type" type="xsd:date" relevant="/pact_demo_form/recent_medical_appointment != 'no'" action="hide" required="false()"/>
      <xf:bind id="accompanied" nodeset="/pact_demo_form/accompanied" type="xsd:string" relevant="/pact_demo_form/recent_medical_appointment != 'no'" action="hide" required="false()"/>
      <xf:bind id="talked_about_recent_slash_upcoming_appointments" nodeset="/pact_demo_form/talked_about_recent_slash_upcoming_appointments" type="xsd:string"/>
      <xf:bind id="reviewed_patient_apos_s_cd4" nodeset="/pact_demo_form/reviewed_patient_apos_s_cd4" type="xsd:string"/>
      <xf:bind id="completed_new_qsp" nodeset="/pact_demo_form/completed_new_qsp" type="xsd:string"/>
      <xf:bind id="topic_1_-_introduction" nodeset="/pact_demo_form/topic_1_-_introduction" type="xsd:string"/>
      <xf:bind id="topic_2_-_using_a_pillbox" nodeset="/pact_demo_form/topic_2_-_using_a_pillbox" type="xsd:string"/>
    </xf:model>
  </head>
  <body>
    <xf:group id="1">
      <xf:label>PACT Demo Form</xf:label>
      <xf:input bind="pact_office_visit">
        <xf:label>PACT Office Visit (Time)</xf:label>
      </xf:input>
      <xf:input bind="home_visit">
        <xf:label>Home Visit (Time)</xf:label>
      </xf:input>
      <xf:input bind="outpatient">
        <xf:label>Outpatient (Time)</xf:label>
      </xf:input>
      <xf:select1 bind="recent_medical_appointment">
        <xf:label>Recent Medical Appointment?</xf:label>
        <xf:item id="yes">
          <xf:label>Yes</xf:label>
          <xf:value>yes</xf:value>
        </xf:item>
        <xf:item id="no">
          <xf:label>No</xf:label>
          <xf:value>no</xf:value>
        </xf:item>
      </xf:select1>
      <xf:select1 bind="recent_medical_appoint_type">
        <xf:label>Recent Medical Appointment Type</xf:label>
        <xf:item id="psychiatry">
          <xf:label>Psychiatry</xf:label>
          <xf:value>psychiatry</xf:value>
        </xf:item>
        <xf:item id="pcp">
          <xf:label>PCP</xf:label>
          <xf:value>pcp</xf:value>
        </xf:item>
        <xf:item id="hiv_md">
          <xf:label>HIV MD</xf:label>
          <xf:value>hiv_md</xf:value>
        </xf:item>
        <xf:item id="gynecology">
          <xf:label>Gynecology</xf:label>
          <xf:value>gynecology</xf:value>
        </xf:item>
        <xf:item id="dental">
          <xf:label>Dental</xf:label>
          <xf:value>dental</xf:value>
        </xf:item>
        <xf:item id="neurology">
          <xf:label>Neurology</xf:label>
          <xf:value>neurology</xf:value>
        </xf:item>
      </xf:select1>
      <xf:input bind="date_of_recent_medical_appointment_type">
        <xf:label>Date of recent medical appointment type</xf:label>
      </xf:input>
      <xf:select1 bind="accompanied">
        <xf:label>Accompanied?</xf:label>
        <xf:item id="yes">
          <xf:label>Yes</xf:label>
          <xf:value>yes</xf:value>
        </xf:item>
        <xf:item id="no">
          <xf:label>No</xf:label>
          <xf:value>no</xf:value>
        </xf:item>
      </xf:select1>
      <xf:select1 bind="talked_about_recent_slash_upcoming_appointments">
        <xf:label>Talked about recent or upcoming appointments?</xf:label>
        <xf:item id="yes">
          <xf:label>Yes</xf:label>
          <xf:value>yes</xf:value>
        </xf:item>
        <xf:item id="no">
          <xf:label>No</xf:label>
          <xf:value>no</xf:value>
        </xf:item>
      </xf:select1>
      <xf:select1 bind="reviewed_patient_apos_s_cd4">
        <xf:label>Reviewed Patient's CD4</xf:label>
        <xf:item id="yes">
          <xf:label>Yes</xf:label>
          <xf:value>yes</xf:value>
        </xf:item>
        <xf:item id="no">
          <xf:label>No</xf:label>
          <xf:value>no</xf:value>
        </xf:item>
      </xf:select1>
      <xf:select1 bind="completed_new_qsp">
        <xf:label>Completed new QSP</xf:label>
        <xf:item id="yes">
          <xf:label>Yes</xf:label>
          <xf:value>yes</xf:value>
        </xf:item>
        <xf:item id="no">
          <xf:label>No</xf:label>
          <xf:value>no</xf:value>
        </xf:item>
      </xf:select1>
      <xf:select bind="topic_1_-_introduction">
        <xf:label>Topic 1 - Introduction</xf:label>
        <xf:item id="conv1_-_introduction">
          <xf:label>Introduction</xf:label>
          <xf:value>conv1_-_introduction</xf:value>
        </xf:item>
        <xf:item id="conv2_-_what_is_hiv">
          <xf:label>What is HIV?</xf:label>
          <xf:value>conv2_-_what_is_hiv</xf:value>
        </xf:item>
        <xf:item id="what_is_your_immune_system">
          <xf:label>What is your immune system?</xf:label>
          <xf:value>what_is_your_immune_system</xf:value>
        </xf:item>
      </xf:select>
      <xf:select bind="topic_2_-_using_a_pillbox">
        <xf:label>Topic 2 - Using a Pillbox</xf:label>
        <xf:item id="medication_list">
          <xf:label>Medication List</xf:label>
          <xf:value>medication_list</xf:value>
        </xf:item>
        <xf:item id="how_to_read_a_pill_bottle">
          <xf:label>How to read a pill bottle</xf:label>
          <xf:value>how_to_read_a_pill_bottle</xf:value>
        </xf:item>
        <xf:item id="steps_to_filling_a_pillbox">
          <xf:label>Steps to filling a pillbox</xf:label>
          <xf:value>steps_to_filling_a_pillbox</xf:value>
        </xf:item>
      </xf:select>
    </xf:group>
  </body>
</html>